Critical Care volume 29,
Article number: 255 (2025)
Background
A systemic inflammatory response can contribute to poor
outcomes in an advanced stage of cardiogenic shock (CS). We investigated the
efficacy of extracorporeal endotoxin and cytokine adsorption using oXiris in
patients with CS undergoing venoarterial extracorporeal membrane oxygenation
(VA-ECMO).
Methods
In this prospective, single-center, randomized, open-label
pilot trial, 40 patients with CS who were undergoing VA-ECMO were randomly
assigned to receive either oXiris for 24 h (n = 20)
or usual care (n = 20). The primary endpoint was
endotoxin levels at 48 h. Secondary endpoints included
changes in inflammatory cytokines, vasoactive-inotropic score (VIS), ECMO
weaning success, and in-hospital and 30-day mortality.
Results
The median endotoxin levels at 48 h were 0.5 (IQR
0.4–1.0) in the oXiris group and 0.4 (IQR 0.2–0.5) in the control group, with
no significant difference between them (P = 0.097). The oXiris group showed
significant temporal reductions in GDF-15 and IL-6 levels, with IL-6 revealing
significant reductions from baseline to 24 h (P = 0.020)
and from baseline to 7 days (P = 0.003). VIS decreased
significantly from baseline to 48 h (-13.63,
95% CI: -20.90 – -6.34, P < 0.001) and 7 days (-12.19, 95% CI: -21.0 – -3.31, P = 0.007)
in the oXiris group, but intergroup differences were insignificant. ECMO
weaning success, duration of ECMO support, and mortality rates were similar
between the groups.
Conclusion
In this pilot study conducted on CS patients requiring
VA-ECMO, oXiris treatment did not significantly reduce endotoxin levels or
improve patient centered clinical outcomes.
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